Pain specialist "duty-bound" to reject medicinal cannabis

Jersey's leading pain specialist has said he is "duty-bound" not to give patients medicinal cannabis as it contradicts his professional guidelines - despite feeling “pressure” to do so following a landmark vote allowing GPs to prescribe it.

The comments came from Dr Chad Taylor, who specialises in treating chronic pain that persists for more than three months.

He told Express that the recent political decision on medicinal cannabis, as well as public expectation, had placed doctors in the difficult position of feeling pushed to prescribe cannabis-derived drugs, even though their professional guidance does not fully endorse their effectiveness or safety.

The consultant explained that the popularity of the medicinal cannabis debate has led patients and lobby groups to feel they are entitled to the drug. "Patients are very interested in the subject... they expect that it is a good treatment for pain and they expect to have it prescribed for them,” he said.

However, Dr Taylor has no intention of bending to this pressure and insists that his only obligation as a medical practitioner is to follow his professional guidance.

He said: “I’m duty-bound to follow my professional guidance, I’m not duty-bound to follow the opinion of the public, or politicians for that matter.”

The guidelines for his area of expertise, which are issued by the Royal College of Physicians (RCP), do not recommend prescribing medicinal cannabis to treat pain.

While the guidelines show that there is positive evidence that medicinal cannabis is an effective treatment for CINV and symptoms of Multiple Sclerosis, its use for pain has not been proven.

The guidelines read: "There is no robust evidence for the use of CBPM [cannabis-based products for medicinal use] in chronic pain and their use is not recommended."

Pictured: Dr Taylor expressed concerns that patients could place pressure on doctors to prescribe medicinal cannabis products because they feel entitled to them following the recent States vote.

The RCP guidelines only came out on 31 October – one week before the question of whether doctors should be allowed to prescribe medicinal cannabis was debated and passed in Jersey’s States Chamber – but Dr Taylor emphasised that now they have been issued, he has “no option” but to follow them.

“The guidance is quite clear… that for chronic, persistent pain that medical cannabis is not recommended. I have no option, I don’t feel, professionally, than to follow that guidance and not prescribe any more new patients with cannabis-based products."

Nonetheless, Dr Taylor said he was aware that his approach may cause friction in dealings with some patients.

"Some will understand it... others will feel that they’re being denied a great treatment because they’ve heard from the media, they’ve heard from our politicians, that this is a great treatment for pain. That is not the clinical view, so there is a difference between what the doctors feel about this and what society and our political leaders feel about this. That, of course, causes a major problem.”

Pictured: Politicians may have led the public to believe that cannabis-derived products are a "great treatment" to prescribe for pain even though this is against official guidance, Dr Taylor said.

He continued: "No doctors requested for this change to take place and I haven’t come across a doctor colleague on the island yet who would be keen to prescribe cannabis for pain."

The pain specialist and anaesthetist said that politicians’ endorsement of medicinal cannabis also has serious ramifications for the kind of “multi-disciplinary” practice he has dedicated his career to refining.

“Chronic pain is a very difficult condition to treat. It doesn’t usually respond well to the normal medical model of treatment,” Dr Taylor said, adding that chronic pain was better treated via a “multi-disciplinary team looking at the whole picture surrounding the patient and their pain” rather than through the simple prescription of drugs.

Despite his scepticism about prescribing the drug, Dr Taylor said he is open to researching the potential clinical uses of cannabis.

Pictured: Dr Taylor said he would like to see more research about the clinical uses of cannabis.

“I’d be the first person to want to use a drug if I thought it was really effective and had [been] proved to be safe, but, sadly, I can’t be convinced that is the case with cannabis and cannabis-based products at the moment.”

The law change surrounding the prescription of medicinal cannabis by GPs is set to take effect in February.

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Posted by
Chris Coomer
on
Nov 28th, 2018

I'm late to the party.

Sativex, which is overpriced cannabis oil, is already available locally, and is deemed safe enough that it is available off licence - meaning it can be prescribed for any condition.

It has already been made quite clear that it is proven relief not only for the treatment of spacisity in MS patients, but is also an effective treatment for neuropathic pain.